Limitations of Keratoplasty in China: A Survey Analysis

Abstract

PurposeEach year, over 8,000 corneal transplantation surgeries are performed in China. Unlike developed countries, which have established standard requirements for operative experience for corneal specialists, little information exists on surgical training for keratoplasty in China. The aim of this study was to assess the keratoplasty experience of Chinese corneal specialists and to characterize their surgical patterns.MethodsOne hundred and twenty-one corneal specialists in 16 provinces (65 cities) in China were invited to complete an anonymous survey at the 2014 Chinese Corneal Society annual meeting, which consisted of questions with single or multiple-choice answers. Demographics, the number and type of keratoplasties performed, and the perceived limiting factors for performing keratoplasties were analyzed.ResultsAn overwhelming 89% response rate was achieved. Of the 108 respondents, 76% worked in tertiary centers, and only 23% held a medical doctorate degree. Furthermore, 69% of the participants had received corneal fellowship training of less than one year. Only 71% were capable of keratoplasties. Among those doing keratoplasty, 68% performed less than 50 keratoplasties each year. Of the same group of keratoplasty surgeons, 88% of corneal specialists capable of keratoplasties had performed penetrating keratoplasties, 87% had performed lamellar keratoplasties, 12% had performed deep anterior lamellar keratoplasties, and 5% had performed Descemet’s stripping endothelial keratoplasties. When questioned on the reasons for the low number of keratoplasties performed in China, the respondents deemed the following factors most important: lack of surgical training (71%), a shortage of donor supply (52%), and a lack of curricula (42%). A multivariate logistic regression analysis showed that corneal transplantation capabilities are significantly associated with responders’ education levels and training time.ConclusionKeratoplasty surgery experience is suboptimal for Chinese corneal specialists. Penetrating and lamellar keratoplasties are the preferred surgical patterns. Our findings raise concerns about the adequacy of keratoplasty training in China.

A Novel Tectonic Keratoplasty with Femtosecond Laser Intrastromal Lenticule for Corneal Ulcer and Perforation

“…The cornea is the most commonly transplanted organ worldwide. [ 8 ] In the USA, 42,642 corneal transplantations were done in 2010, compared with 12,623 solid organ transplantations in 2008, including kidney, liver, lung, pancreas, heart, and intestine. [ 9 ] In the past 10 years, the number of keratoplasty in China has been about 8000 per year.…”

“…[ 9 ] In the past 10 years, the number of keratoplasty in China has been about 8000 per year. [ 8 ] However, cornea donors cannot match the demand worldwide, especially in the developing countries.…”

“…A survey conducted in 2014 has demonstrated that a shortage of donor supply had been considered as the first difficulty in the treatment of corneal disease in China. [ 8 ] In this study, we applied the intrastromal lenticule extracted from SMILE procedure as corneal patch graft in the tectonic keratoplasty. We report our experience about this novel approach in a series of cases.…”

Long-Term Observation of Triplex Surgery for Cataract after Phakic 6H Implantation for Super High Myopia

“…Another limitation of our study is that the DSAEKs were among the initial 50 cases performed in our hospital. However, in real world, such experience is especially useful due to the limitations associated with keratoplasty in China [ 37 ]. Such a retrospective study enables anticipation of the most complicated problems of these cases to determine the optimal surgical time.…”

Full-thickness conjunctival flap covering surgery combined with amniotic membrane transplantation for severe fungal keratitis

“…Despite receiving an accurate diagnosis and appropriate treatment, 15–27% of patients with fungal keratitis require corneal transplantation ( 9 ). Although the complexity and difficulty of keratoplasty are considerable disadvantages, the cornea donor shortage is an underlying limitation of this procedure for treating patients with fungal keratitis ( 10 ). There is a lack of corneal donation despite the high demand in China, with 200 patients registering for corneal donations and only 60 eyes donated within the past decade, as indicated in a study by Shang and Zhang in 2010 ( 11 ).…”